The majority of general practitioners are self-employed independent contractors. Since 2004 the general medical services (GMS) covers all independent contractors who have not opted to become a personal medical services (PMS) practice (known as Section 17C provider in Scotland). Approximately 60% of practices are on GMS contracts. GP practices, rather than individual GPs, contract with the primary care organisation (PCO) to provide general medical services.
This contract (and thus practices) is funded via a number of different streams:
- the global sum (the sum of money per patient)
- the Quality and Outcomes Framework
- minimum practice income guarantee (MPIG)
- enhanced services (e.g. identifying dementia)
- seniority payments
- dispensing for dispensing practices.
Practices' entitlements to this funding are detailed in the Statement of Financial Entitlements. GPs' earnings are then determined by the practice's own business arrangement, whether this be as a single-handed practitioner, a partnership, or a company limited by shares.
The level of funding and the level of entitlements to practices are negotiated nationally.
GPs can also work as salaried employees. Their terms and condition and salary are negotiated between the GP and the employer. In recent years, DDRB have tended to consider salaried GPs as comparable to employed doctors when recommending any uplift to their pay.
A salaried GP may be employed by a GP practice (GMS, PMS or Section 17C), by a primary care organisation or a private provider commissioned by the primary care organisation to provide primary medical services.
The BMA provide a model contract for salaried GPs containing minimum terms and conditions of service, and salary range, updated annually by the DDRB, which we recommend should apply.
In Wales, there is a separately negotiated salaried GP contract for those GPs employed directly by the GMS practice and the local health board.
Personal medical services (PMS) and Section 17C schemes
Personal medical services and Section 17C agreements are local alternatives to the national general medical services contracts. Originally a pilot project, PMS and Section 17C agreements became permanent on 1 April 2004 and terms of service are now governed by overarching regulations.
Although the contract budget remains locally negotiated between contractor and PCO, and the various elements of that budget are not nationally protected as in GMS. PMS and Section 17C agreements are becoming increasingly similar to GMS. PMS contractors have equal access to many of the new sources of income negotiated under the new GMS contract, such as the Quality and Outcomes Framework.
GP trainees' pay is currently calculated on their basic salary in their last junior hospital or consultant post, plus a supplement of 45 per cent. This is reviewed annually by the DDRB.
Doctors' retainer and flexible careers scheme
The GP retainer and flexible careers schemes are designed to ensure that doctors who can only undertake a small amount of paid professional work may keep in touch with general practice, retain their skills and progress their careers, with a view to returning to NHS general practice in the future.
The schemes combine a service commitment with an educational component.
These doctors are classed as salaried GPs, and therefore, the agreed minimum terms and conditions of service and salary range for salaried GPs apply to these doctors when employed by a GMS practice or primary care organisation, if this employment started on or after 1 April 2004. The BMA recommends the same for salaried GPs at PMS practices or private providers.